CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Results: From 2011 to 2016, HIV incidence dropped by 56%, from 2.31 to 1.03 new HIV diagnoses per 100 individuals screened annually (Table 1). Meanwhile, the number of consultations for PrEP increased exponentially and gradual increases were observed in number of PEP treatments and proportion of seropositive patients having an undetectable viral load, which reached 95% by 2016. Both the number of individuals screened annually and the number of tests per person increased from 2011 to 2016, by 47% and 31%, respectively. Conclusion: This data shows a major drop in HIV incidence within the past five years. This decline, in parallel with the exponential increase in PrEP initiations, confirms the importance of ensuring PrEP is available to everyone who should need it. It is important to underline, however, this decline was already in progress and is likely attributable, at least in part, to progress towards treatment as prevention and other preventive efforts. Also, these results only represent the experience of one major clinic in Montreal. Continued efforts to monitor the potential influence of PrEP and other combined prevention methods on new HIV cases at a population level are essential.

In line with Montreal’s Fast-Track City Initiative, the support of PrEP and other combined prevention measures remain key to ending the epidemic by 2030. 1039 USING HIV INCIDENCE ESTIMATES TO INFORM GUIDELINES FOR THE PrEP IMPACT TRIAL Martina Furegato, Paula Blomquist, Sarika Desai, Hamish Mohammed, Holly Mitchell, Monica Desai, Owen N. Gill, John Saunders Public Health England, London, UK Background: Individuals who are clinically assessed to be at similar risk of HIV acquisition (>2 per 100 person-years) as HIV-negative individuals with a serodiscordant partner who is not known to be virally suppressed (<200 copies per ml) are considered to be eligible for HIV Pre-Exposure Prophylaxis (PrEP) in England. In order to support clinicians in making this assessment, we used HIV incidence estimates from surveillance data to define risk groups who may benefit from PrEP in England. Methods: We reviewed longitudinal data from GUMCAD, the national sexually transmitted infections (STI) surveillance system in England, on attendees at sexual health clinics. The incidence of HIV per 100 person-years (95% confidence intervals) for attendees with a history of HIV testing, post-exposure prophylaxis for HIV (PEPSE), bacterial STIs or use of drugs in a sexual context before or during last sexual intercourse was determined using the Kaplan-Meier method. Separate analyses were performed for MSM and heterosexuals. Results: Among MSM, the incidence of HIV was greatest in those who were diagnosed with infectious syphilis (4.5) in the past year followed by those prescribed at least one course of PEPSE (3.9) in the past year and by those diagnosed with a bacterial STI (3.6) in the past year and by those who used drugs in a sexual context (3.6) before or during the last sexual intercourse (Table 1). Among heterosexuals, the HIV incidence was below 1 per 100 person-years in all the sub-groups included (Table 1). Conclusion: More heterosexuals than MSM are diagnosed with HIV outside the sexual health clinics, so in this study the incidence in the heterosexual group is underestimated. However, given the high degree of variability in HIV risk among MSM and heterosexuals, these findings provide evidence to guide clinical risk assessment an essential step to accessing PrEP. This may help clinicians target patients more efficiently, thus maximising the impact of PrEP.

Poster Abstracts

1038 HIGH SEROCONVERSION RATES FOLLOWING PrEP DISCONTINUANCE IN A MONTREAL CLINIC Zoe Greenwald, Marieve Beauchemin, Khadija Benomar, Gabrielle Landry, Michel Boissonnault, Louise Charest, Danièle Longpré, Stéphane Lavoie, Réjean Thomas Clinique Médicale l’Actuel, Montreal, QC, Canada Background: Variations in individual PrEP use have been described by the seasons of risk theory; whereby patients may start and stop PrEP episodically. However, measures of rates of episodic PrEP use, reasons for PrEP discontinuation and rates of seroconversion following PrEP stops are scarce. Methods: We aim to measure rates of temporary and permanent PrEP discontinuations describe stop reasons and measure seroconversion rates subsequent to stops using the Actuel PrEP cohort (Montreal). We included PrEP users who had initiated PrEP and returned for ≥1 follow-up visit prior to September 2017 (N=1258). We describe PrEP discontinuation as: (1) temporary or (2) permanent discontinuations reported at a follow-up visit, or (3) patients lost to follow-up for ≥6 months. We describe the reported stop reasons and HIV incidence rates subsequent to discontinuance. Person-time at risk was calculated from stop date to date of seroconversion or else censored at last negative routine HIV test among patients who were maintained in care. Results: Our cohort measured 450 consistent PrEP users (36%), 114 PrEP users (9%) who temporarily stopped and re-initiated PrEP at least once, 214 individuals who permanently discontinued PrEP (17%) and 480 individuals who have been lost to follow-up (38%). HIV incidence following discontinuation was 3.9 cases per 100 PY. Among individuals who discontinued PrEP, the most commonly reported stop reasons were side effects (14%), cost of PrEP or loss of private insurance (9%), individual preference (7%), and changes in sex life, such as entry into a stable relationship with seronegative partner (13%), entry into relationship with seropositive undetectable partner (4%), breakup with seropositive partner (4%) or sexual abstinence (10%). Conclusion: This study adds evidence to the theory that, for some, PrEP use is a transient rather than constant HIV prevention method. However, the high rates of seroconversion following PrEP discontinuance indicate the need for clinical support which takes into consideration contextual lifestyle factors that may lead individuals to stop PrEP, while remaining at high risk for HIV infection. In turn, appropriate risk counseling for those who stop PrEP and the development of resources to reduce loss to follow-up among PrEP users should be implemented.

1040 PrEP INTEREST AND HIV-1 INCIDENCE AMONG MSM AND TRANSGENDER WOMEN IN COASTAL KENYA Makobu Kimani 1 , Elisabeth M. van der Elst 1 , Oscar Chirro 2 , Clifford Oduor 1 , Elizabeth Wahome 1 , Winston Kazungu 1 , Mahmoud Shally 2 , Don Operario 3 , Susan M. Graham 4 , Eduard Sanders 2 1 Kenya Medical Research Institute, Kilifi, Kenya, 2 KEMRI Wellcome Trust Rsr Prog, Kilifi, Kenya, 3 Brown University, Providence, RI, USA, 4 University of Washington, Seattle, WA, USA Background: Pre-exposure Prophylaxis (PrEP) has recently been added as one of the combination HIV prevention methods by the Kenyan Health Ministry. Data on willingness to take PrEP and the association between PrEP interest and HIV-1 incidence among gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) are lacking. We aimed to assess PrEP interest and HIV-1 incidence in GBMSM and TGW. Methods: With assistance from 10 peer educators from a GBMSM community- based organization, we recruited HIV-1 negative GBMSM who had participated

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